1316202005 NPI number — MICHAEL ANDREW MERCURIO MD

Table of content: MICHAEL ANDREW MERCURIO MD (NPI 1316202005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316202005 NPI number — MICHAEL ANDREW MERCURIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCURIO
Provider First Name:
MICHAEL
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANOCKI
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
ANDREW
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316202005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 9TH AVE
Provider Second Line Business Mailing Address:
M4-PFS
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-515-5811
Provider Business Mailing Address Fax Number:
206-341-0274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 SENECA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-341-0637
Provider Business Practice Location Address Fax Number:
206-341-1401
Provider Enumeration Date:
07/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD60681518 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)